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Sensitivity of plain radiography for pediatric cervical spine injury

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Abstract

Pediatric patients with suspected cervical spine injuries (CSI) often receive a computed tomography (CT) scan as an initial diagnostic imaging test. While sensitive, CT of the cervical spine carries significant radiation and risk of lethal malignant transformation later in life. Plain radiographs carry significantly less radiation and could serve as the preferred screening tool, provided they have a high functional sensitivity in detecting pediatric patients with CSI. We hypothesize that plain cervical spine radiographs can reliably detect pediatric patients with CSI and seek to quantify the functional sensitivity of plain radiography as compared to CT. We analyzed data from the NEXUS cervical spine study to assess the sensitivity of plain radiographs in the evaluation of CSI. We identified all pediatric patients who underwent plain radiographic imaging, and all pediatric patients found to have CSI. We then determined the sensitivity of plain radiographs in detecting pediatric patients with CSI. We identified 44 pediatric patients with CSI in the dataset with age ranging from 2 to 18 years old. Thirty-two of the 44 pediatric patients received cervical spine plain films as a part of their workup. Plain films were able to identify all 32 pediatric patients with CSI to yield a sensitivity of 100 % in detecting injury victims (95 % confidence interval 89.1–100.0 %). Plain radiography was highly sensitive for the identification of CSI in our cohort of pediatric patients and is useful as a screening tool in the evaluation of pediatric CSI.

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Authors and Affiliations

  1. Department of Emergency Medicine, University of California, Los Angeles, 924 Westwood Blvd, Suite 300, Los Angeles, CA, 90095, USA

    Li W. Cui

  2. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Marc A. Probst

  3. UCLA School of Medicine, Los Angeles, CA, USA

    Jerome R. Hoffman

  4. UCLA - Emergency Medicine Center, UCLA Geffen School of Medicine, Los Angeles, CA, USA

    William R. Mower

Authors
  1. Li W. Cui
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  2. Marc A. Probst
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  3. Jerome R. Hoffman
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  4. William R. Mower
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Corresponding author

Correspondence to Li W. Cui.

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The authors declare that they have no conflict of interest.

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Author contributions

LWC, MAP, WRM, and JRH participated in the project development, data analysis, manuscript composition, and critical review. WRM and JRH participated in data collection.

Appendix

Appendix

The following centers and investigators collaborated in the NEXUS study: principal investigator—W. Mower; co-investigator—J. Hoffman; steering committee—J. Hoffman, W. Mower, K. Todd, A. Wolfson, and M. Zucker; site investigators—Antelope Valley Medical Center (Los Angeles): M. Brown and R. Sisson; Bellevue Hospital (New York): W. Goldberg and R. Siegmann; Cedars–Sinai Medical Center (Los Angeles): J. Geiderman and B. Pressman; Crawford Long Hospital (Atlanta): S. Pitts and W. Davis; Egleston Children’s Hospital (Atlanta): H. Simon and T. Ball; Emory University Medical Center (Atlanta): D. Lowery and S. Tigges; Grady Hospital (Atlanta): C. Finney and S. Tigges; Hennepin County Medical Center (Minneapolis): B. Mahoney and J. Hollerman; Jacobi Medical Center (Bronx, N.Y.): M. Touger, P. Gennis, and N. Nathanson; Maricopa Medical Center (Phoenix, Ariz.): C. Pollack and M. Connell; Mercy Hospital of Pittsburgh (Pittsburgh): M. Turturro and B. Carlin; Midway Hospital (Los Angeles): D. Kalmanson and G. Berman; Ohio State University Medical Center (Columbus): D. Martin and C. Mueller; Southern Regional Hospital (Decatur, Ga.): W. Watkins and E. Hadley; State University of New York at Stony Brook (Stony Brook): P. Viccellio and S. Fuchs; University of California, Davis, Medical Center (Sacramento): E. Panacek and J. Holmes; University of California, Los Angeles, Center for the Health Sciences (Los Angeles); J. Hoffman and M. Zucker; University of California, San Francisco, Fresno University Medical Center (Fresno, Calif.): G. Hendey and R. Lesperance; University of Maryland Medical Center (Baltimore): B. Browne and S. Mirvis; University of Pittsburgh Medical Center (Pittsburgh): A. Wolfson and J. Towers; Hermann Hospital, University of Texas Health Sciences Center (Houston): N. Adame, Jr., and J. Harris, Jr.

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Cui, L.W., Probst, M.A., Hoffman, J.R. et al. Sensitivity of plain radiography for pediatric cervical spine injury. Emerg Radiol 23, 443–448 (2016). https://doi.org/10.1007/s10140-016-1417-y

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  • DOI: https://doi.org/10.1007/s10140-016-1417-y

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